Provider Demographics
NPI:1568529790
Name:VILLERS, SHELLY (MA, LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:VILLERS
Suffix:
Gender:F
Credentials:MA, LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MEHLDAL ROAD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26181
Mailing Address - Country:US
Mailing Address - Phone:304-861-0188
Mailing Address - Fax:
Practice Address - Street 1:601 AVERY ST STE 400
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5111
Practice Address - Country:US
Practice Address - Phone:304-428-6012
Practice Address - Fax:304-428-6031
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9205066000Medicaid